Provider Demographics
NPI:1861533176
Name:A FULL LIFE HOME HEALTH LEWISTON INC
Entity type:Organization
Organization Name:A FULL LIFE HOME HEALTH LEWISTON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-746-8881
Mailing Address - Street 1:102 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1936
Mailing Address - Country:US
Mailing Address - Phone:208-746-8881
Mailing Address - Fax:208-746-5694
Practice Address - Street 1:102 11TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1936
Practice Address - Country:US
Practice Address - Phone:208-746-8881
Practice Address - Fax:208-746-5694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health